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Microscopic examination of bile
Last reviewed: 04.07.2025
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Normal bile does not contain cellular elements; sometimes a small amount of cholesterol crystals and calcium bilirubinate is present.
Mucus in the form of small clumps indicates catarrhal inflammation of the bile ducts, duodenitis.
Erythrocytes have no diagnostic value, since they often appear as a result of trauma during probing.
Leukocytes. Leukocytes found in small flakes of mucus in combination with the epithelium of the bile ducts or gall bladder are of diagnostic value. The presence of leukocytes only in portion A is observed in duodenitis and in inflammatory phenomena in large bile ducts. Detection of leukocytes mainly in portion B, with a lower content in portions A and C, indicates the localization of the inflammatory process in the gall bladder. The predominance of leukocytes in portion C is noted in cholangitis. A significant number of leukocytes in all fractions of bile is observed in weakened elderly patients with septic cholangitis and liver abscesses. Eosinophilic leukocytes are found in allergic cholecystitis, cholangitis and helminthic invasions.
Epithelium. High prismatic ciliated epithelium is characteristic of cholecystitis, small prismatic cells of the liver ducts or high prismatic epithelium of the common bile duct - for cholangitis. Large cylindrical cells with cuticle and villi indicate pathology in the duodenum.
Malignant neoplasm cells can be detected in the contents of the duodenum in neoplasms.
Cholesterol crystals. Their number increases with changes in the colloidal stability of bile (cholelithiasis). They usually accumulate together with other crystalline elements of bile - microliths, calcium salts (calcium bilirubinate), crystals of fatty and bile acids.
Normally, all crystalline elements are absent; their presence indicates a violation of the normal colloidal properties of bile, that is, the pathological process of cholelithiasis.
Sterility. Normal bile is sterile. In parasitic diseases, vegetative forms of lamblia, helminth eggs (opisthorchiasis, fascioliasis, clonorchiasis, dicrocoeliasis, strongyloidosis, trichostrongyloidosis) are found in bile. Detection of intestinal eelworm and liver fluke in bile causes significant difficulties, therefore, if strongyloidiasis and fascioliasis are suspected, multiple studies are indicated.
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